Original Investigation
Pathogenesis and Treatment of Kidney Disease
Bleeding Complications of Native Kidney Biopsy: A Systematic Review and Meta-analysis

https://doi.org/10.1053/j.ajkd.2012.02.330Get rights and content

Background

Kidney biopsy provides important information for nephrologists, but the risk of complications has not been systematically described.

Study Design

Meta-analysis of randomized controlled trials and prospective or retrospective observational studies.

Setting & Population

Adults undergoing native kidney biopsy in an inpatient or outpatient setting.

Selection Criteria for Studies

MEDLINE indexed studies from January 1980 through June 2011; sample size of 50 or more.

Intervention

Native kidney biopsy with automated biopsy device and real-time ultrasonographic guidance.

Outcomes

Macroscopic hematuria and erythrocyte transfusion rates and factors associated with these outcomes.

Results

34 studies of 9,474 biopsies met inclusion criteria. The rate of macroscopic hematuria was 3.5% (95% CI, 2.2%-5.1%), and erythrocyte transfusion was 0.9% (95% CI, 0.4%-1.5%). Significantly higher rates of transfusion were seen with the following: 14-gauge compared with smaller needles (2.1% vs 0.5%; P = 0.009), studies with mean serum creatinine level ≥2.0 mg/dL (2.1% vs 0.4%; P = 0.02), ≥50% women (1.9% vs 0.6%; P = 0.03), and ≥10% of biopsies for acute kidney injury (1.1% vs 0.04%; P < 0.001). Higher transfusion rates also were observed in studies with a mean age of 40 years or older (1.0% vs 0.2%; P = 0.2) and mean systolic blood pressure ≥130 mm Hg (1.4% vs 0.1%; P = 0.09). Similar relationships were noted for the macroscopic hematuria rate with the same predictors, but none was statistically significant.

Limitations

Publication bias, few randomized controlled trials, and missing data.

Conclusions

Native kidney biopsy using automated biopsy devices and real-time ultrasonography is associated with a relatively small risk of macroscopic hematuria and erythrocyte transfusion requirement. Using smaller gauge needles may lower complication rates. Patient selection may affect outcome because studies with higher serum creatinine levels, more women, and higher rates of acute kidney injury had higher complication rates. Future studies should further evaluate risk factors for complications.

Section snippets

Data Sources and Searches

We conducted a PubMed search of English-language studies published from January 1, 1980, through June 27, 2011. The MeSH (medical subject heading) terms and subheadings used were kidney, biopsy/needle, biopsy/fine needle, biopsy/adverse effects, and biopsy/complication. Each MeSH term was used in combination with the text words “biopsy” and “kidney. Additional studies were identified through a manual search of the bibliographies in retrieved studies.

Study Selection

One author (K.M.C.) performed the literature

Description of Included Studies

The initial search yielded 2,472 studies (Fig 1). Of these, 2,173 were deemed ineligible because they were not related to the study question. We reviewed the full text of the remaining 299 studies for possible inclusion and excluded 265 studies based on selection criteria. Thirty-four publications were included for analysis (Table 1).15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48 Thirty studies provided data

Discussion

This study presents what to our knowledge is the first systematic review and meta-analysis of hemorrhagic complications after percutaneous native kidney biopsy using ultrasonographic guidance and an automated spring-loaded biopsy device. We confirmed that the rate of major and minor complications is relatively low when native kidney biopsies are performed using the current technique. Both macroscopic hematuria and need for erythrocyte transfusion are important complications of kidney biopsy

Acknowledgements

Support: None.

Financial Disclosure: The authors declare that they have no relevant financial interests.

References (53)

  • D.M. Burstein et al.

    The use of the automatic core biopsy system in percutaneous renal biopsies: a comparative study

    Am J Kidney Dis

    (1993)
  • A. Constantin et al.

    Percutaneous US-guided renal biopsy: a retrospective study comparing the 16-gauge end-cut and 14-gauge side-notch needles

    J Vasc Interv Radiol

    (2010)
  • N. Islam et al.

    Do platelet function analyzer-100 testing results correlate with bleeding events after percutaneous renal biopsy?

    Clin Nephrol

    (2010)
  • K.-M. Yeow et al.

    Risk factors for pneumothorax and bleeding after CT-guided percutaneous coaxial cutting needle biopsy of lung lesions

    J Vasc Interv Radiol

    (2001)
  • L.T. Kohn et al.

    To Err Is Human: Building a Safer Health System

    (2000)
  • T.A. Brennan et al.

    Incidence of adverse events and negligence in hospitalized patients: results of the Harvard Medical Practice Study I. 1991

    Qual Saf Health Care

    (2004)
  • C.E. Gordon et al.

    Pneumothorax following thoracentesis: a systematic review and meta-analysis

    Arch Intern Med

    (2010)
  • D. Hind et al.

    Ultrasonic locating devices for central venous cannulation: meta-analysis

    BMJ

    (2003)
  • R.P. Myers et al.

    Utilization rates, complications and costs of percutaneous liver biopsy: a population-based study including 4275 biopsies

    Liver Int

    (2008)
  • U. Backman et al.

    Percutaneous renal biopsy with real-time ultrasonography

    Scand J Urol Nephrol

    (1982)
  • D.M. Burstein et al.

    Percutaneous renal biopsy with the use of real-time ultrasound

    Am J Nephrol

    (1991)
  • A.M. Ahmed et al.

    Percutaneous renal biopsy by automated biopsy gun

    J Coll Physicians Surg Pak

    (2003)
  • S.H. Ballal et al.

    Percutaneous renal biopsy: a single center experience with automated spring-loaded “gun” type device

    Clin Nephrol

    (1995)
  • J. Riehl et al.

    Percutaneous renal biopsy: comparison of manual and automated puncture techniques with native and transplanted kidneys

    Nephrol Dial Transplant

    (1994)
  • H. Lübbers et al.

    A new fine needle for easier, single handed, ultrasound-guided biopsies, requiring less advancing forces into solid organs

    Z Gastroenterol

    (1993)
  • D.P. Worth et al.

    The biopty cut procedure for renal biopsies

    Br Med J

    (1988)
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    Originally published online April 26, 2012.

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